Your Digest for Wednesday, Jan 31, 2024 09:59 AM


[!TIP] mnemonic: 'flozins' are SGLT-2 inhibitors
Glucose 'flowz in' the PCT

General properties of hypoglycaemic agents

Protective effects of hypoglycemic agents

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Source

Evidence on protective effects of hypoglycemic agents

oralHypoglycemicsBenefitsEvidence.pngSource

Indications for selecting a hypoglycemic agent

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| Agent | Class | Mechanism | Side effects | Other stuff | Expected effect |
| ------------------------------------------------ | -------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Metformin | Biguanide | Insulin sensitiztion Reduce hepatic gluconeogenesis. | GI side effects Lactic acidosis (risk in renal/liver/heart failure – contrindications) No weight gain May reduce apetite, STOP when eGFR < 30 | Reduced GI B12 absorption The usual first line agent, can be combined with other | Lower FBS by about 50 mg/dL Lowers HbA1C by about 1% |
| Pioglitazone is the only one | Thiazolidinediones (glitazones) | Increases insulin sensitivity by binding nuclear receptors and altering gene expression may increase glucose consumption in muscle cells | no hypoglycaemia Commonly weight gain Fluid retention → precipitates Heart failure | May specifically benefit NAFLD | take up to 3 months to reach maximal effect. |
| Gliclazide Glimipiride Glibenclamide Tolbutamide | Sulphonylureas | Promotes depolarization of beta cell → stimulates insulin secretion (by binding ATP dependent k+ channel) | Weight gain! Hypoglycaemia | Effect will wear off with age as beta cell mass declines Risk of hypoglycaemia increases with age and intercurrent infection and duration of drug action Gliclazide / Glipizide / tolbutamide → Short acting Glimiperide → ? long acting but lower hypo risk Glyburide(= Glibenclamide) – long acting | Similar to metformin Weight gain of 1-4 Kg |
| Repaglinide | Meglitinides ("slp.ureas lite") | Post prandial insulin releasers (binds ATP dependent k+ channel like sulfonylureas) but act only for 3 hrs. So effective only in post prandial period when taken with meals | Hypoglycaemia Weight gain (but less than s.ureas) | Taken about 30 minutes before meals. | Less effective than other drugs. Role in DM Mx is not clear. Can be used with metformin is C/I or when patient only has post prandial hyperglycaemia |
| Sitagliptin Linigliptin | DPP-4 inhibitors (gliptins) | Inhibit GLP-1 breakdown (restore physiologic GLP levels) → promotion of insulin secretion GLP1 receptors are also found in the cardiovascular system | Good S/E profile. | Used as second line drug, in early DM when insulin secretion is still preserved. Combined with metformin / sulfonylurea | Modest effect but used because of low S/E profile. |
| Empagliflozin Dapagliflozin Canagliflozin | SGLT inhibitors | Inhibit the coupled reabsorption of sodium and glucose from the proximal tubules (+ other renal effects) | Dehydration Genital candidiasis (but not bacterial UTI),Can precipitate DKA (increase production of ketones) | Wonder drug! Decreases weight Improve renal dysfuntion – renoprotective Reduce atherosclerotic events! Reduce risk of heart failure | ?More potent glucose lowering than metformin(values given in K&C). Weight loss of 2-4 Kg over 1 year |
| GLP - Agonists - See Below | | | | | |
| | | | | | |


- *GI symptoms*

extrapulmonary manifestations:

Diagnosis: fastidious organism, use PCR

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[!INFO] Ergot Vs. Non Ergot antiparkinson medications: Fibrosis Vs Non fibrotic

[!TIP] Mnemonic:

Ergot derived NON ergot
Fungal PeLiCan B PramOnRottinRope
Pergolide, Lisuride, Cabergoline, Bromocriptine pramipexole, ropinirole, rotigotine

  1. Humans can get infected by

[!INFO] See [[#Comparison of amoebiasis and giardiasis]] below

Comparison of amoebiasis and giardiasis

Amoebiasis Giardiasis Cyclosporiasis
Protozoan Protozoan
Cyst is infective Cyst is infective
Cysts survive in environment Cysts survive in environment
faeco-oral transmission Faeco-oral transmission
Cysts resistant to gastric acid Cyst resistant to chlorine
Trophozoites cause disease Same
Invasive Usually not invasive Sporozoites invade small intestinal epithelial cells
Trophozoites localize in large intestine Small intestine Small intestine
Cyst ?immediately infective Cyst immediately infective Cyst must mature for days to weeks in environment -> human to human transmission unlikely.
Metronidazole / paromoycin Tinidazole / metro TMP + SMX

  1. Patient is clinically well.